President Barack Obama signed into law the quickie bill that reversed the sustainable growth rate (SGR) cut of 24 percent to Medicare reimbursements to the nation’s physicians.

The bill also postponed implementation of ICD-10 for one year to Oct. 1, 2015, and extended the moratorium on Medicare Recovery Audit Contractors (RACs) from reviewing claims submitted under the controversial “two-midnight rule” for six additional months for a period to extend from Oct. 1, 2013 to April 1, 2015.

According to mediareports, the bill, which originated in the House of Representatives, was passed by way of legislative sleight of hand, and conservatives in the House were outraged. Conservatives reportedly had been told there would be no vote on the bill, but Congressional leadership apparently snuck the bill through the House by a voice vote.

One of those caught by surprise, Rep. Rick Mulvaney (R-S.C.), opposed the bill because funding for it will come from cuts that will have to be made in the future. The Congressman last week referred to the funding mechanism as “bull-@#$%&,” but after meeting with Republican leadership yesterday softened his stance. “I tried to focus today on the practical impacts of it,” he told Roll Call. “Put the internal politics aside, put the maneuvering aside, and say, ‘OK, we just spent $6 billion that we don’t have, how are we going to pay for it?’”

One answer is contained in the House Budget Committee proposal released yesterday by Chairman Paul Ryan (R-Wisc.). The committee is proposing to cut government spending for healthcare by $2.9 trillion while at the same time creating a reserve fund to replace future SGR reductions. The savings will result by establishing a “Medicare exchange” for workers currently under 55 and instituting greater means testing for beneficiaries of Medicare Parts B and D. Medicaid would be reduced by $732 billion over a decade by turning it into a block grant program and other reforms.